Venous stasis, deep venous thrombosis and airline flight: can the seat be fixed?

Deep venous thrombosis (DVT) and pulmonary embolization (PE) associated with air travel are directly related to the duration of flight and seating in non-aisle seats. In this study, we assessed a modification of a standard airline seat (NewSit) designed to decrease the incidence of DVT on long flights. This seat raises the feet from the floor, facilitates mobility, and permits intermittent calf compression.

Integrated approach to construction and maintenance of prosthetic arteriovenous access for hemodialysis.

Autogenous arteriovenous access is the preferred access for hemodialysis patients with end-stage renal disease but is not feasible in a significant number of patients. The creation of a prosthetic arteriovenous access (PAVA) for hemodialysis using expanded polytetrafluoroethylene is technically simple and the short-term results are usually good, but the PAVA's 1-year patency rate is low (less than 60% in many centers). We have developed an integrated approach for the creation and maintenance of PAVAs, under the direction of a dedicated vascular access surgeon, involving preoperative imaging, anesthetic and surgical techniques, and a postoperative graft surveillance program, to improve patency rates.

Primary forearm arteriovenous fistula for hemodialysis access--an integrated approach to improve outcomes.

Purpose: Maximizing the ratio of primary arteriovenous fistula (PAVF) over bridge graft fistula (BGF) for hemodialysis access is a primary recommendation of the National Kidney Foundation published as Dialysis Outcomes Quality Initiative (DOQI). Imaging, anesthetic and surgical techniques were taken into account to achieve this and other goals, including extensive use of forearm vessels to lower immediate and early failure rates and prolong the useful life of PAVFs.

Design: Prospective non-randomized study.

The predictive value of the halo sign in color Doppler ultrasonography of the temporal arteries for diagnosing giant cell arteritis.

Objective: The diagnosis of giant cell arteritis (GCA) usually requires a temporal artery biopsy. Recently it has been reported that a periluminal dark halo, detected by color Doppler ultrasonography (US) of the temporal arteries, is a characteristic sign of GCA. We evaluated the predictive value of this dark halo sign in diagnosing GCA.

Dialysis access induced limb ischemia corrected using quantitative duplex ultrasound.

Dialysis access induced limb ischemia (DAILI) is a rare complication after the creation of an arteriovenous fistula in infancy but can cause irreversible ischemic limb damage in severe cases. The incidence of DAILI is higher in bridge graft fistulas than in native fistulas. DAILI patients may be managed by surgically reducing the volume flow in the fistula.

Management of dialysis access-associated steal syndrome: use of intraoperative duplex ultrasound scanning for optimal flow reduction.

Dialysis access-associated steal syndrome (DASS) is an uncommon complication after the creation of an arteriovenous fistula and can cause irreversible ischemic damage in severe cases. Dialysis access-associated steal syndrome has been managed with the surgical reduction of the volume flow in the fistula, but this is associated with a certain incidence of access loss. Several methods are described to achieve the delicate balance between essential flow in the fistula and an adequate limb perfusion pressure.

Primary blast injury after a bomb explosion in a civilian bus.

A 6-kg explosive charge detonated under a seat in the center of a crowded city bus in Jerusalem, killing three passengers immediately. Of the 55 survivors, all of whom were transferred to two major medical centers, 29 were hospitalized. Among those admitted, a high rate of primary blast injuries was found, including perforated ear drums (76%), blast lung (38%), and abdominal blast injuries (14%).

Spontaneous rupture of the stomach: a rare complication of Nissen's fundoplication.

Spontaneous rupture of the stomach may occur in cases of abnormal distension and reduced emptying capacity, either by normal peristalsis or by vomiting, of the stomach. We present a case of spontaneous rupture of the stomach in which the dilatation was due to apple fermentation and gas formation in the stomach. Peristalsis was inadequate for stomach emptying due to impaction of apple skins in the duodenum.

Rectal temperature in the diagnosis of acute lower abdominal pain.

The accurate diagnosis of acute lower abdominal pain continues to be a problem. In Israel, a diagnostic sign often sought as indicating pelvic peritonitis is a rectal temperature of greater than 1.0 C higher than the simultaneous oral temperature.

The use of photoplethysmography in the assessment of venous insufficiency: a comparison to venous pressure measurements.

In an attempt to develop a noninvasive test to assess objectively the magnitude of venous valvular dysfunction in pathologic states, photoplethysmography (PPG) was compared to venous pressure in the saphenous vein at the ankle. Simultaneous venous pressure and PPG recordings were taken before, during, and after exercise with subjects in the sitting position. In a total of 338 paired measurements in 24 normal, 25 postphlebitic, and 14 varicose limbs, PPG and venous pressure tracings appeared to be identical; data points had a correlation coefficient of great significance (r = 0.

Hypopharyngeal injury as a result of attempted endotracheal intubation.

Perforation of the hypopharynx due to traumatic attempted endotracheal intubation usually occurs during resuscitation efforts under poor conditions, but may occur even under optimal conditions due to improper technique. The implication of the appearance of subcutaneous emphysema in the neck, cyanosis, or pneumothorax during or following attempts at endotracheal intubation should be known. Direct laryngoscopy may be helpful in establishing the injury but early radiological examination is necessary for diagnosis of the site and extent of the perforation.